Session: Poster session A

A new approach to muscle lengthening surgery in vertical strabismus due to thyroid ophthalmopathy.

Introduction: Our aim in this study is to introduce the new application technique developed by us for muscle lengthening operation with tutopatch, which is used for larger muscle weakening in thyroid-related vertical strabismus, and to evaluate the long-term results.

Method: The files of 9 patients with serious superior gaze limitation and very large vertical hypotropia due to thyroid ophthalmopathy, who were operated on by the same surgeon, were evaluated retrospectively. Vertical deviation amount was evaluated in the primary position. Full upward gaze was considered as 0 and failure to reach the midline was considered as -5, for vertical gaze limitation evaluation, Lid retraction was evaluated according to the amount of scleral show between the lower lid edge and the inferior margine of the limbus, counting every 0.5 mm as (+)..Post operative evaluations was taken from the patients' first year follow-up. 

Operation technique:  In the operation, the pericardium is placed between the distal part of the muscle tendon and the beginning of the muscle fibers, as much as the planned amount of recession.

Results: The patients were between 35-62 years old and 5 were men and 4 were women. Preoperatively,their deviation amount was between 14-30 prism diopter (pd) and except for two all had -4 and more upward gaze limitation  Postoperatively, these values was found as 0-4 pd vertical deviation in primary position and  0-(-2) vertical gaze restriction. There were no noticeabe lower lid retraction in any of our cases.

Conclusion: Based on the results we obtained from this small series, we concluded that the new application is safe and effective method with permanent results in thyroid-related vertical deviations.